Fisher Michael, Salottolo Kristin, Carrick Matthew, Corrigan Chad M, Banton Kaysie L, Madayag Robert, Bar-Or David
Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA.
Medical City Plano, Medical City Healthcare, Irving, Texas, USA.
Trauma Surg Acute Care Open. 2024 Feb 21;9(1):e001282. doi: 10.1136/tsaco-2023-001282. eCollection 2024.
The perioperative management of patients on antiplatelet drugs is a rising challenge in orthopedic trauma because antiplatelet drugs are frequently encountered and carry an increased risk of hemorrhagic consequences. The study objective was to examine the effect of aspirin on bleeding outcomes for patients with lower extremity fractures.
This retrospective study included patients requiring surgical fixation of traumatic hip, femur, and tibia fractures from January 1, 2018, to March 1, 2020. Patients were excluded if they had a significant head injury, were on chronic anticoagulant therapy, or they did not receive venous thromboembolism chemoprophylaxis. Comparisons between aspirin users (patients on aspirin therapy preinjury) and non-aspirin users were examined using χ tests, Cochran-Mantel-Haenszel tests, and multivariate logistic regression. The primary outcome was an overt, actionable bleed (eg, blood transfusion for surgical site hemorrhage) within 24 hours postoperative.
There were 864 patients with lower extremity long bone fractures and 24% were aspirin users. The incidence of postoperative bleeding was 8.8% and significantly differed for patients taking aspirin versus not (13.6% vs 7.3%, p=0.01). However, biological sex at birth (M/F) was a significant effect modifier (interaction p=0.04). Among women, there were significantly more postoperative bleeds for aspirin users (17.8% aspirin vs 7.4% no aspirin, adjusted OR (AOR): 2.48 (1.28-4.81), p=0.01). Among men, there were similar postoperative bleeding events by aspirin use (5.6% aspirin vs 7.2% no aspirin, AOR: 0.50 (0.14-1.82), p=0.30). Postoperative hemoglobin values <8 g/dL were more frequent among female aspirin users (21.5% aspirin vs 12.5% no aspirin, p=0.01), but this association was not observed in men (p=0.43).
Women taking aspirin who suffer lower extremity fractures have greater than twofold greater odds of a postoperative bleeding event. These findings suggest adequate perioperative planning to ensure blood availability, and increased awareness to monitor closely for hemorrhage in the 24-hour postoperative window for women taking aspirin preinjury.
IV.
对于服用抗血小板药物的患者，围手术期管理在骨科创伤领域是一项日益严峻的挑战，因为此类药物在临床上经常使用，且会增加出血风险。本研究旨在探讨阿司匹林对下肢骨折患者出血情况的影响。
本回顾性研究纳入了2018年1月1日至2020年3月1日期间因创伤性髋部、股骨和胫骨骨折需手术固定的患者。若患者有严重头部损伤、正在接受慢性抗凝治疗或未接受静脉血栓栓塞化学预防，则被排除。使用χ检验、 Cochr an-Mantel-Haenszel检验和多因素逻辑回归分析比较服用阿司匹林的患者（受伤前接受阿司匹林治疗）和未服用阿司匹林的患者。主要结局是术后24小时内明显的、可采取措施的出血（如因手术部位出血而输血）。
共有864例下肢长骨骨折患者，其中24%为服用阿司匹林的患者。术后出血发生率为8.8%，服用阿司匹林的患者与未服用者之间存在显著差异（13.6%对7.3%，p=0.01）。然而，出生时的生物学性别（男/女）是一个显著的效应修饰因素（交互作用p=0.04）。在女性中，服用阿司匹林的患者术后出血明显更多（服用阿司匹林者为17.8%，未服用者为7.4%，调整后的比值比（AOR）：2.48（1.28 - 4.81），p=0.01）。在男性中，服用阿司匹林与否的术后出血事件相似（服用阿司匹林者为5.6%，未服用者为7.2%，AOR：0.50（0.14 - 1.82），p=0.30）。女性服用阿司匹林者术后血红蛋白值<8 g/dL更为常见（服用阿司匹林者为21.5%，未服用者为12.5%，p=0.01），但在男性中未观察到这种关联（p=0.43）。
下肢骨折且服用阿司匹林的女性术后出血事件的几率高出两倍多。这些发现提示需要进行充分的围手术期规划以确保血液供应，并提高认识，在受伤前服用阿司匹林的女性术后24小时内密切监测出血情况。
IV级
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